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Leal GN et al.
616 Rev Assoc M ed Bras 2016; 62(7):616-617
AT THE BEDSIDE
Image-guided pancreatic biopsy; can we trust it as
a diagnostic alternative?
T hiago Queroz1, Wanderley Marques Bernardo2, Marcos Roberto de Menezes3
1MD, Radiologist, Hospital Sírio-Libanês, São Paulo, SP, Brazil
2Programa Diretrizes, Brazilian Medical Association
3MD, Coordinator of the Centro de Intervenção Guiada por Imagem, Hospital Sírio-Libanês, São Paulo, SP, Brazil
Introduction
Most pancreatic adenocarcinomas are unresectable at the
time of diagnosis,1 or present image limitations in the
case of non-adenocarcinomas,2 thus posing a challenge
for adequate histological sampling without the aid of
laparoscopy. The American Joint Committee on Cancer
considers the endoscopic ultrasound-guided diagnostic
puncture as a procedure of choice.3 In recent years, with
advances in imaging methods, computed tomography
(CT) and percutaneous ultrasound have become a diag-
nostic alternative in case of failure diagnosis, with the
possibility of collecting histological fragments.4-8
Method
Retrospective cohort analysis of hospital records of pa-
tients undergoing ultrasound-guided percutaneous bi-
opsy and/or CT scan based on positive or negative histo-
logical findings in patients undergoing the percutaneous
technique as first alternative or after failure of an endo-
scopic technique. We used the same pathology laborato-
ries for the analysis of our histological fragments.
Results
Fifty-five image-guided percutaneous biopsies were
included, 11 of which had undergone prior endoscopic
attempt with negative results. The average age was 62
years; 25 patients were male and 30 female. The mean
size of the lesion was 4.75 cm, with 55% in the head and
45% in the body/tail of the pancreas. Positive results
were possible in 85% of the cases, with 36 adenocarci-
nomas; three B-cell lymphomas and four metastases
(two gastrointestinal tract, one renal, one pulmonary);
one epithelial microcystic lesion; two neuroendocrine
tumors; and one chronic pancreatitis. Of the 11 cases
of prior negative biopsy by endoscopy, we were able to
reach a diagnosis in 72%, with seven adenocarcinomas
and one epithelial microcystic lesion. All results were
obtained with only a minor complication character-
ized by a self-limited perihepatic hematoma. There
was no tumor dissemination in the puncture needle
path (Table 1).
Conclusion
In cases of negative endoscopic biopsies of pancreatic
lesions, the ultrasound-guided percutaneous and/or CT
method can be an effective and safe alternative for histo-
logical diagnosis.
Keywords: cancer, biopsy, CT-guided biopsy, pancre-
atic tumor.
TABLE 1Positive results of image-guided percutaneous biopsies of pancreatic lesions.
Results Number of patients
Adenocarcinoma 36
Lymphoma 3
Metastasis* 4
Epithelial microcystic lesion 1
Neuroendocrine 2
Chronic pancreatitis 1
Total 47
*Two gastrointestinal tract; one renal; and one small cell lung carcinoma.